While many clinicians believe myopia stabilizes after adolescence, adult high myopia progression remains a significant clinical challenge. Identifying patients at high risk of axial elongation is essential to prevent permanent vision loss. Consequently, the Wenzhou High Myopia Cohort Study investigated optimal predictors for this condition in a large group of adults. Researchers followed over 500 patients to determine why some eyes continue to lengthen well into adulthood.

Predicting Adult High Myopia Progression

The prospective study enrolled 1025 eyes from 532 adults aged 18 to 60. Specifically, the team defined rapid axial elongation as an increase of at least 0.10 mm over two years. Their analysis successfully constructed a predictive model using six key variables. These variables include age, sex, and baseline axial length. Furthermore, best-corrected visual acuity, choroidal thickness (ChT), and vascularity index significantly improved the model's accuracy. Notably, the full model achieved a high discriminative ability with an AUC of 0.811.

The Critical Role of Choroidal Thickness

Among all factors, choroidal thickness emerged as the most powerful individual predictor for future elongation. When researchers removed ChT from their predictive model, the accuracy dropped substantially. Additionally, age remains a primary factor in determining risk. Younger adults typically exhibit much higher rates of elongation compared to older cohorts. Therefore, monitoring these structural changes provides clinicians with a clearer picture of a patient's risk profile. Using these six predictors allows for more targeted management of high-risk individuals.

Clinical Implications for Management

Understanding these predictors helps doctors identify which adults require closer observation. Since nearly 25% of high myopes in the study experienced rapid elongation, routine monitoring is vital. Specifically, assessing choroidal thickness and vascularity through advanced imaging can guide treatment decisions. Consequently, this data-driven approach supports the prevention of complications like macular degeneration or retinal detachment. Focusing on these metrics ensures that intervention occurs before irreversible damage happens.

Frequently Asked Questions

What constitutes rapid axial elongation in adults?

In this clinical study, rapid axial elongation refers to an increase in eye length of 0.10 mm or more over a two-year follow-up period.

Which ocular factor is the strongest predictor of myopia progression?

Choroidal thickness (ChT) showed the highest individual ability to predict future axial elongation, outperforming other baseline measurements like axial length itself.

Does myopia always stop progressing after age 18?

No, this research demonstrates that approximately 24.78% of adults with high myopia continue to experience rapid axial elongation between the ages of 18 and 60.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or a professional relationship. Always consult a qualified healthcare provider for personal health concerns. Refer to the latest local and national guidelines for clinical practice.

References

Wang Y et al. Prediction of axial elongation in adults with high myopia: the Wenzhou High Myopia Cohort Study. Eye Vis (Lond). 2026 Jun 22. doi: undefined. PMID: 42324575.

Kong K, et al. Axial elongation and risk factors for high myopia in young adults. Am J Ophthalmol. 2024.

Zhang S, et al. Axial Elongation Trajectories in Chinese Children and Adults With High Myopia. JAMA Ophthalmol. 2024.